Laxatives and eating disorders: Signs of abuse and potential dangers

What are laxatives?

Laxatives are a class of medication that help promote bowel movement. There are several types of laxatives which work in different ways, including:¹

• Bulk-forming laxatives: Generally considered the gentlest form of laxative, these work by adding soluble fiber to the stool. This draws water from the body into the stool, making it bigger and bulkier, subsequently stimulating the colon to contract.
• Osmotic laxatives: These draw water directly from the body into the stool, making it softer and easier to pass. Saline laxatives are considered a type of osmotic laxative.
• Stool softener laxatives: Also called emollient laxatives, these medications increase the water and fat levels absorbed by the stool, making it easier to pass.
• Lubricant laxatives: As the name suggests, these laxatives work by coating the colon in a lubricant substance, making the tract slick so that stool can pass through it.
• Stimulant laxatives: On the stronger end of laxatives, these stimulate the nerves in the colon directly, forcing the movement to move stool along.

While many types of laxatives are available over-the-counter, they're generally intended to be used only as needed. Each type of laxative will have more specific instructions on how often it can or should be used.

Laxatives, diuretics, and eating disorders

Laxatives and eating disorders often go hand-in-hand.

The most common—or else, the most frequently studied—connections are between people with bulimia nervosa (BN) and laxatives and those with anorexia nervosa (AN) and laxatives. It's estimated that anywhere from 10% to 60% of people with these conditions have abused these medications.²

For many, misusing laxatives is considered a form of purging, with the medication believed to help people lose weight, eliminate calories, or just generally feel "lighter" or thinner.³ Still, others may experience constipation as a GI complication of their eating disorder and turn to laxatives for relief.⁷

Diuretics are also commonly misused to produce similar results. This class of drug is meant to treat high blood pressure by helping the kidneys remove salt and water from the blood.⁴ But they also result in frequent urination, which some people with eating disorders may see as another way to purge or reduce perceived bloating.

Laxatives and eating disorders: Debunking the myths

While it's true that laxatives can lead to some weight loss, this has nothing to do with food or calories. What's being eliminated is water weight and along with it, electrolytes and minerals, which can result in dangerous imbalances.³ The loss is also short-lived, with the weight generally returning as soon as the person rehydrates.³

And laxatives do not truly eliminate unwanted calories from the body. Many factors affect the breakdown of food and when calories are absorbed, but most absorption generally happens in the small intestine. By the time food reaches the large intestine—the organ targeted by laxatives—nearly all calories are typically already absorbed by the body.³

Laxative abuse and eating disorders

Despite its ultimate ineffectiveness, laxative abuse is frequent among people with eating disorders.

Broadly, the term refers to taking the medication in ways other than medically directed. This can look like taking large quantities at a time, taking smaller doses more frequently than recommended, or taking laxatives when not feeling constipated, among other behaviors.⁶

The behavior has been linked with longer illness duration, higher prevalence of borderline personality disorder (BPD) and related features like suicide attempts, impulsivity, and greater eating disorder pathology or ways of thinking that support disordered eating behaviors.⁵

It's also common for people who misuse laxatives to develop a laxative dependency, which can be both psychologically and physically driven. Stimulant laxative abuse, in particular, can lead the intestines to lose nerve response, which can cause genuine constipation and the need to take more laxatives, which become less and less effective over time, requiring higher doses and building even more dependency.⁶

Signs and symptoms of laxative misuse

Laxative use is generally a very private matter, but there are some outward signs that can point to laxative misuse, including:^3,6

• Dehydration, which can cause:some text
  • Thirst
  • Headache
  • Decreased urination
  • Lightheadedness
  • Dry mouth
  • Weakness
  • Blurry vision
  • Fainting
  • Tremors
• Blood in the stool
• Rectal prolapse

Someone struggling with an eating disorder may engage in secretive behavior around food, eating, and mealtimes and may also try to hide their use of laxatives.

Health risks of laxative abuse 

Laxative abuse can lead to several physical complications, including:^3,6

• Loss of nerve sensitivity in the large intestine, leading to chronic constipation
• Electrolyte imbalances, which can lead to issues with:some text
  • Heart health
  • Muscle and nerve function
  • Colon function
• Severe dehydration
• Irritable bowel syndrome
• Colon infection
• Alternating constipation, diarrhea, and gas
• In rare cases, liver damage or a heightened risk of colon cancer
• In extreme cases, death

Finding treatment for laxatives and eating disorders 

Treating laxative abuse can be uncomfortable, but it's extremely important.

In general, the best strategy is to stop using laxatives altogether rather than to wean yourself off them.⁶ To help, you should dispose of all laxatives you have and look for outside support to help with any potential urges to use. Coming up with alternative plans, such as going for a walk when you want to use a laxative, can also be useful.⁶

Those quitting laxatives may experience immediate constipation. If this happens to you, you can work on other ways to help your body become more naturally "regular," such as:⁶

• Drinking at least 8 cups of fluids per day
• Gradually increasing your fiber intake
• Eating. meals and snacks on a regular schedule
• Moving your body regularly
• Eat enough on a daily basis

If laxative abuse is taking place alongside an eating disorder, it's essential to pursue other types of help to address the additional mental and physical health concerns at play.

If you need help figuring out where to start, you can speak to your primary care physician or therapist for recommendations on your best next steps. You can also reach out to us at Within Health. We provide a team of multidisciplinary experts who can address all the various aspects of eating disorders, including the connection to laxative misuse.

Regardless of where you reach out, seeking help is important. Laxative misuse can be dangerous or even deadly if left untreated, but with the appropriate care and attention, it can be a thing of the past.